aminophylline (theophylline) ethylenediamine) (Rx)

Adult: PO 6 mg/kg, then 3 mg/kg q6 hr × 2 doses, then 3 mg/kg q8 hr maintenance, max 900 mg/day or 13 mg/kg; PO in CHF 6 mg/kg, then 2 mg/kg q8 hr × 2 doses, then 1- 2 mg/kg q12 hr maintenance; IV 4.7 mg/kg, then 0.55 mg/kg/hr × 12 hr, then 0.36 mg/kg/hr maintenance; IV in CHF 4.7 mg/kg, then 0.39 mg/kg/hr × 12 hr; then 0.08- 0.16 mg/kg/hr maintenance Geriatric and in cor pulmonale: PO 6 mg/kg, then 2 mg/kg q6 hr × 2 doses, then 2 mg/kg q8 hr maintenance; IV 4.7 mg/kg, then 0.47 mg/kg/hr × 12 hr, then 0.24 mg/kg/hr maintenance Child 9- 16 yr: PO 6 mg/kg, then 3 mg/kg q4 hr × 3 doses, then 3 mg/kg q6 hr maintenance, max 18 mg/kg/day 12- 16 yr, or 20 mg/kg/day 9- 12 yr; IV 4.7 mg/kg, then 0.79 mg/kg/hr × 12 hr, then 0.63 mg/kg/hr maintenance Child 6 mo- 9 yr: PO 4 mg/kg q4 hr × 3 doses, then 4 mg/kg q6 hr maintenance, max 24 mg/kg day; IV 4.7 mg/kg, then 0.95 mg/kg/hr × 12 hr, then 0.79 mg/kg/hr maintenance Infant 6- 52 wk: Dose (0.2× age in wk) \div 5 × kg = 24 hr dose in mg Neonate up to 40 wk premature postconception age: PO/IV 1 mg/kg q12 hr Neonate at birth or 40 wk postconception age: PO/IV >8 wk postnatal 1- 3 mg/kg q6 hr; 4- 8 wk postnatal 1- 2 mg/kg q8 hr; up to 4 wk postnatal 1- 2 mg/kg q12 hr Hepatic disease

Adult: PO 6 mg/kg, then 2 mg/kg q8 hr × 2 doses, then 1- 2 mg/kg q12 hr maintenance; IV 4.7 mg/kg, then 0.39 mg/kg/hr × 12 hr, then 0.08- 0.16 mg/kg/hr maintenance

Available forms: Inj 250 mg/10 ml, 500 mg/20 ml, 100 mg/100 ml in 0.45% NaCl; 200 mg/100 ml in 0.45% NaCl; rectal supp 250 mg, 500 mg; oral liq 105 mg/5 ml; tabs 100, 200 mg; cont rel tabs 225, 350 mg

Implementation Give around the clock to maintain blood (theophylline) levels If switching from IV to PO, give controlled- release dose at time IV infusion is discontinued; if giving tab (immediate release), discontinue IV and wait >4 hr If GI upset occurs, take with 8 oz of water or food Increase fluids to 2 L/day

PO route: Do not break, crush, or chew enteric- coated or cont rel tabs Avoid giving with food

Continuous IV infusion route: May be diluted for IV inf in 100- 200 ml in D_{5}W D_{10}W D_{20}W 0.9% NaCl, 0.45% NaCl, LR Give loading dose over \frac{1}{2} hr, max rate of inf 25 mg/min, use infusion pump; after loading dose, give by cont inf Avoid IM inj; pain and tissue damage may occur Only clear sol; flush IV line before dose; store diluted sol for 24 hr if refrigerated

Syringe compatibilities: Heparin, metoclopramide, PENTobarbital, thiopental

Y- site compatibilities: Allopurinol, amifestone, amphotericin B sulfate complex, in- amrinone, aztreonam, cefTAZidine, cimetidine, cladribine, DOXOrubicin liposome, enalaprilat, esmolol, famotidine, filgrastim, fluconazole, fludarabine, foscarnet, gallium, granisetron, heparin sodium with hydrocortisone sodium succinate, labetalol, melphalan, meropenem, netilmicin, PAClitaxel, pancuronium, piperacillin/tazobactam, potassium chloride, propofol, ranitidine, remifentanil, sargramostim, tacrolimus, teniposide, thiotepa, tolazoline, vecuronium Y- site incompatibilities: DOBUTamine, hydrALAZINE, ondansetron